Permit •
CITY OF TIGARD MECHANICAL PERMIT
l COMMUNITY DEVELOPMENT Permit #: MEC2011 00594
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011
Parcel: 2S111DD06800
Jurisdiction: Tigard
Site address: 15735 SW 88TH AVE
Project: RUBOTTOM Subdivision: STRATFORD Lot: 65
Project Description: Gas piping to range.
Contractor: ACCURATE PLUMBING & HVAC LLC Owner: RUBOTTOM, GRAYDEN A & DEBORAH L
3021 NE 72ND DR #924 15735 SW 88TH AVE
VANCOUVER, WA 98661 TIGARD, OR 97224
PHONE: 360- 944 -8952 PHONE:
FAX: 360- 896 -4870
FEES
•
Specifics: Description Date Amount
Fuel Piping 12/21/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 12/21/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/21/2011 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _01111111111111111111111111 Permittee Signature: Q2- e-
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application ��� FOR OFFICE 1. SE ONLY
- City of Tigard � rQ \` Received }� 2 „t / Perm N o.:
C R i3 t25 SW Hall Blvd., Tigard, OR 97223 Date/By: / lU
Phone: 503.718.2439 Fax: 503 `98.1960 Qv r fi r , a Other Permit:
TI GA RD Inspection Line: 503.639 0V �V e Ready/By: arais: RI Sec Pagc 2 for
Internet: www.tigard or.gov C � �� �
. � Notified/Method: Supplemental Information
TYPE OF WORK ��1� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
D New construction Addition /alteration/replacement performed. Indicate the value (founded to the neatest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT f SYSTEMS FEES*
I - and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building For special information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description ] Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: /5.73 S 5 - 14 ) 5' (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City / State/ZIP: - � ,i/ 9 7.2Z t Furnace 100,000+ BTU (ducts'vents) 54.91
Suite/bldg./apt. no.: Pro ject name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system _ 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric)
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no : • Floc/vent for any of above 23.32
Other: 23.32 _
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
/ /,4': 6( Gas vent fireplace 33.39
/ 7 O �i/ �? Flue vent foor water heater or gas
fireplace 23.32 _
rd ; Geis /1 .. - ,. �/ &7�ie. Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 23.32
Other. _ 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone
( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: S14.15 for first four; $4.03 for each add Mortal_
Address: Furnace, etc.
Gas heat pump
City /State/ZIP:
Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water healer
Fireplace
E-mail: age /
CONTRACTOR Barbecue
Business name: / 14 4-c Clothes dryer (gas)
Carl. r Aidy., lit"' .� Other:
Address: 302_/ /t./. y� � i.v MECHANICAL PERMIT FEES*
Ci /State /Z[P: / Subtotal
Phone: (540) rJ 944 - e95 j Fax: (. 4, ep g7 _ ��
g� Minimum permit fee ($90.00) rte, t/1!
'
Plan review (25% of permit five)
CCBlie.: / 9078 ! State surcharge (12% of permit fee) Itd - tf)
TOTAL PERMIT FEE /a), g7)
This permit application expires if a permit is not obtained within 180
Authorized signature: T- -- / d ays a fter it has been accepted at complete.
Print name: L� Cd�/�7!/y'/ Date /, �r /,�p,�/ / * Fee methodology set by Tri -Comity Building Industry Service Beard .
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